Hermeneutics and nursing theory

Menu

Daily Archives: 20/10/2013

In Being and time Heidegger sets out to elevate the traditional, metaphysical understanding of being as a universal to a higher level that lays the ground for his important insight of ontological difference: being is not just any being, nor is it simply “every possible determination existent in a being” (Heidegger, 1996, p. 38). The starting point of Heidegger’s fundamental ontology is that “being is not a genus of beings” (ibid.). Heidegger differentiates being (Sein) from beings (Seiende), even if the latter is in every instance appropriated by the former in the Ereignis of fundamental understanding. Being transcends beings – but Heidegger is careful not to repeat the metaphysical understanding of transcendens as koinon, but to ground it in what he calls the ecstatic-temporal unity of the hermeneutic horizon that allows us to think being beyond beings (ibid., marginal remark). Given that the hermeneutic circle is, methodologically speaking, the interpretative consequence of ontological difference, its circularity has a universal structure embedded in the nature of understanding. Understanding itself has the universality of transcendence in that every understanding has understanding of being (Seinsverständnis) as its ground.

The being of care (Sorge) in nursing is the patient – the sick as distinct from the healthy. Resonating with Heidegger’s fundamental ontology in method and in structure, a hermeneutic nursing theory is grounded not in the koinon of patient care, which is the brute fact of the sickness of patients, but in the specific being-with (Mitsein) of nurse and patient that allows for the universality of hermeneutic circle to be grounded through dialogue and communication, which necessarily involve understanding and interpretation. In existential terms, both nurse and patient are thrown (geworfen) together into a situation where there is an implicit understanding of healing or, in the case of terminal illness, palliative care. However, given that the patient is not an object but a person, i.e. a Dasein capable of uncovering the meaning of its being, the situation in nursing care is necessarily hermeneutic. What a hermeneutic nursing theory does is to make this ontological facticity explicit.

For Heidegger, experience places Dasein in a hermeneutic situation in that on the primordial level, it concerns itself with the understanding of being as the uncovering of the truth of being of Dasein, so that the meaning of being of Dasein can come within its horizon of comprehensibility. In contrast to the mood of French existentialism, the affliction of disease is not absurd, but has a meaning waiting to be interpreted and integrated into the whole or holon of the patient’s being. The suffering and possibly shortened life expectancy brought about by disease, whether acute or chronic, places the being of a patient in a situation where there is a sense of urgency in making sense of how to continue with life.